Related Experiment Video
Updated: Aug 30, 2026
The WATCHMAN Left Atrial Appendage Closure Device for Atrial Fibrillation
Published on: February 28, 2012
Stroke risk in anticoagulated patients with atrial fibrillation undergoing endoscopy
David J Blacker1, Eelco F M Wijdicks, Robyn L McClelland
1Department of Neurology, Mayo Clinic, Rochester, MN 55905, USA.
Insights
The stroke risk for anticoagulated atrial fibrillation (AF) patients undergoing procedures is low, but significantly higher in complex cases. Factors like age and medical history increase stroke risk.
Area of Science:
- Cardiology
- Neurology
- Gastroenterology
Background:
- Atrial fibrillation (AF) necessitates anticoagulation to prevent stroke.
- Endoscopic procedures (bronchoscopy, gastroscopy, colonoscopy) often require temporary anticoagulation adjustment.
- The stroke risk associated with adjusted anticoagulation during these procedures is not well-defined.
Purpose of the Study:
- To assess the stroke risk in patients with AF undergoing endoscopies with adjusted anticoagulation.
- To identify patient-specific factors that may influence stroke risk in this context.
Main Methods:
- Retrospective review of patients with AF undergoing endoscopies between 1995 and 2001.
- Analysis focused on patients whose anticoagulation was adjusted for the procedure.
- Calculation of stroke rate within 30 days post-procedure.
Main Results:
- A total of 12 strokes occurred in 987 patients across 1,137 procedures (1.06% stroke rate).
- Stroke risk varied from 0.31% in routine cases to 2.93% in complex patients.
- Increased stroke risk was associated with complexity, age over 80, history of stroke, hypertension, hyperlipidemia, and family history of vascular disease.
Conclusions:
- Adjusting anticoagulation for endoscopic procedures in AF patients carries a low overall stroke risk.
- Patients with complex clinical situations face a nearly tenfold higher risk of stroke.
- Age, prior stroke, hypertension, hyperlipidemia, and family history are significant risk factors for stroke in this population.
Objective:
To determine the risk of stroke in anticoagulated patients with atrial fibrillation (AF) when anticoagulation is adjusted for bronchoscopy, gastroscopy, or colonoscopy, and to identify factors that could modify this risk.
Methods:
The authors reviewed patients with AF undergoing endoscopies between 1995 and 2001, with specific analysis of patients with AF in whom anticoagulation was adjusted for the procedures. The authors calculated the stroke rate within 30 days of the procedures.
Results:
Twelve strokes occurred in 987 patients undergoing 1,137 procedures (1.06%/procedure). The risk ranged from 0.31% for patients with nonvalvular AF undergoing routine procedures to 2.93% for complex patients undergoing endoscopies combined with other procedures or with comorbid illnesses. Patients with stroke were more likely to be complex (7/12 vs 219/975, p = 0.04); to be older than 80 years (6/12 vs 187/975, p = 0.017); to have a history of stroke (7/12 vs 194/975, p = 0.004), hypertension (10/12 vs 508/975, p = 0.04), or hyperlipidemia (9/12 vs 334/975, p = 0.005); or to have a family history of vascular disease (10/12 vs 502/975, p = 0.039).
Conclusions:
The risk of stroke in patients with AF whose anticoagulation is adjusted for endoscopies is low, but almost tenfold higher in patients with complex clinical situations. Age, history of stroke, hypertension, hyperlipidemia, and family history of vascular disease may increase the risk of stroke.
Related Concept Videos
01:29Venous Thrombosis III: Interprofessional Care
01:22Aneurysm IV: Nursing Management
01:28Cardiac Catheterization I: Pre-Procedure Overview
01:30Anticoagulant Drugs: Low-Molecular-Weight Heparins
01:29Endoscopic Procedures I: Esophagogastroduodenoscopy
During an EGD, the endoscope can be used to: